Primecare Medical Group LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME80045 Issued in FL

Legal business name

PRIMECARE MEDICAL GROUP LLC

Practice address

2638 Narnia Way Unit 101
Land O Lakes, FL 34638-7321

Phone

(813) 909-0760

Fax

(813) 949-7394

NPI assigned

Jul 23, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Martin Revello

Title

President

Phone

(813) 932-0996

Specialties & licenses 1

Addresses

Other names 1

• Primecare Medical of Land o Lakes Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Verimed Health Group Carrollwood, LLC

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1336268788

  O20070808000366

  Same enrollment

Tax ID family

Primecare Medical Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Primecare Medical Group

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1093720427
  NPD tax ID
• Verimed Health Group Carrollwood, LLC

  • Internal Medicine Physician
  • Tampa, FL
  • NPI 1336268788
  NPD tax ID

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Barbara Calderon-Vizcarrondo, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Tampa, FL
  • NPI 1104050640
  NPD
• Fernando Diaz Mori, M.D.

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1093972143
  NPD
• Francis J Mercado-Miranda, MD

  • General Practice Physician
  • Beverly Hills, FL
  • NPI 1821654153
  NPD
• Auxi Peachey, MD

  • Internal Medicine Physician
  • Riverview, FL
  • NPI 1356439509
  NPD
• Samuel Anibal Fuentes Flores

  • General Practice Physician
  • Aguadilla, PR
  • NPI 1457718546
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272844800000",
    "number": "1932339926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2638 NARNIA WAY UNIT 101",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346387321",
            "telephone_number": "813-909-0760",
            "fax_number": "813-949-7394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2638 NARNIA WAY UNIT 101",
            "city": "LAND O LAKES",
            "state": "FL",
            "postal_code": "346387321",
            "telephone_number": "813-909-0760",
            "fax_number": "813-949-7394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMECARE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-23",
        "last_updated": "2010-05-03",
        "status": "A",
        "authorized_official_last_name": "REVELLO",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-932-0996",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME80045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primecare Medical of Land o Lakes",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Powers, APRN
• Practical Psychiatric Solutions
• Kathryn Sierra Prado, DMD
• Premium Transportion, LLC
• Michelle Price-Wolff, LMHC
• Matthew Prince, RN
• Providers Healthcare Staffing LLC
• Providers on Call, Inc
• Psychiatry for All
• Publix Super Markets Inc

• Internal Medicine Physician in Land O Lakes, FL
• Providers in Land O Lakes, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.